Am I pro-psychiatry? Well, not exactly.

This is quite a long post, so get comfortable.

This blog isn’t one that is full of impassioned polemic like some others; it’s a very personal blog that’s exactly what it says on the tin; the life of a manic depressive and the many myriad joys and breathless excitement of living with severe mental illness and being treated for it. Mental illness is how I see it, an illness, not a construct, not an idea, but an illness akin to diabetes, but with less pissing, that I am fighting.  So that’s me.

I am hyper, distracted and irritable as a Yorkshire terrier at the moment so trying to focus my rapidly shifting thoughts is a mission,  but here is where I attempt to explain my views on psychiatry and mental illness.

I think that all people, with whatever views on this, need to respect the other even if they disagree because many are writing from the perspective of someone who’s been in the psychiatric system or who is/diagnosed with mental illness, and their opinions will be informed by their highly personal experiences.  So I will try to be even-handed and balanced in this post, rather than attack anyone.

There is no fully objective source of either pro-psychiatry opinion or anti, and that’s important to bear in mind.  It’s also important to bear in mind that I’m twenty three years old.  I’m also fully aware of the problem of confirmation bias when considering research.  I will go through this post with links and citations in a bit, I just want to get it down for now.  If there’s anything in which I’m displaying spectacular ignorance on, tell me!

I’m one of the more pro-psychiatry bloggers out there.  I’m often challenged via comments and e-mail to explain myself.

I think that many mental health bloggers in the UK are more supportive of psychiatry, as the psychiatric profession and the pharmaceutical industry operates in a vastly different manner here than to the US because we have the tax funded NHS as opposed to private healthcare.  Many US mental health bloggers talk disdainfully of the “Big Pharma”, and in the culture of the US, I can absolutely understand their disdain.  That is a country which advertises mind and body altering medications on television in between commercials for Oreos, which is downright baffling and so ethically wrong.  It’s also a country which most have to shell out small fortunes for the time of a psychiatrist, paid for as a member of a private corporation, and a raft of medications that are sold to them.

In the UK, most of us are in the National Health Service, in which we don’t pay for our treatment, and in which most psychiatrists have little to gain from prescribing medication.  We see a GP, and they refer us onwards.  In the case of depression, people are often treated solely by their GP. For other people referred onto psychiatrists, some will be in the care of a community mental health team, and that model of treatment is therapeutic, with medical treatment adjacent. It is far less of a business model than it is in the US.

I am also one of the most critical of alternative medicines and homeopathic treatments, as you might have noticed with a cursory glance at my “People I Like” blogroll. Although I’m alright with vitamins, Omega 3, exercise and that kind of thing as complementary medicine (and, of course, what you put into your body undoubtedly affects how you feel), but I don’t think that it should be used in cases of severe illness of any kind as a replacement for medical treatment.   I am critical of spiritualism, disgusted by money peddling homeopathic treatments which are basically water and aghast at the receding reputation of science.  This extends far beyond my opinions of mental illness.

Some people may see this as a contradiction; psychiatry is not technically a science, as there is no standardized tests for mental illness, there is no one treatment for mental illness, so how is it different from the snake oil treatments sold by those who espouse homeopathy?   Well, when the latter have some sort of scientific backing, and non anecdotal nor vested interest evidence, I’ll consider them.

My opinion it is that psychiatry is a fledgling science that uses blunt but sometimes effective tools.  It is new.  I support its progression, not destruction. I do believe that mental illness is biologically based.   I may be entirely proved wrong there (and if there is scientific proof otherwise, I welcome being proven wrong) but for now, with what I’ve read and experienced, that’s what I believe. The brain is an organ!

However, is that I think there is a difference between mental illness and mental disorders.  I think that Axis I disorders such as depressive and anxiety disorders, mood disorders and psychotic disorders (in particular schizophrenia) are biologically based, but aggravated by environmental factors, whereas personality disorders and other similar things (like Body Dysmorphic Disorder, which is something that I suffer from) are environmentally based, and aggravated by biological factors.  My reason for this is that depressive, mood and psychotic disorders are observed to run in families, there is a wealth of genetic research into them and that they do (and they do) often respond to medication, however, you and I will differ in our definition of “respond”.  Personality disorders are seen to have strong links to childhood abuse and trauma, whereas although this does occur in mental illness, it’s not the rule.  The use of medication in personality disorders is usually for psychotic or depressive symptoms that may occur with them.  And of course, personality disorders and other such things can be swimming alongside clinical depression and manic depression.

That doesn’t mean that I consider one more “real” than the other.  All I think is that they have different possibly different causes, therefore possibly different treatment.  Nor is it the prevailing “I’m really mental” snobbery of people with manic depression in the blogosphere!  I use BPD as an example because it’s the one I’m most familiar with.  That’s not the way I think about things.

However, the problem in separating them is that you wander into the firing squad of “responsibility”.  If mental illness is biologically based then does it mean that a person is not responsible for their behaviour under the influence of symptoms of the illness?  Is a psychopath, which is a diagnosable personality disorder (Antisocial Personality Disorder) responsible for their behaviour which might hurt someone else, or, in some cases, be a feature in the mental make up of an abuser or murderer?  I can only answer with certainty in one case: people with psychosis, who are not personally, as individuals, hurtful, harmful, violent or callous or otherwise (and people are, as people, and it is nothing to do with any mental illness or disorder) are not responsible for their behaviour if acting under the influence of psychosis; i.e a delusion.

Culturally, schizophrenia is possibly the worst of mental illnesses to have because it’s viewed as a “murderer” illness.  This is completely and utterly wrong- about 1% of the population have schizophrenia, and 1%, or less, of that 1% will ever kill anyone.  The general population, with no psychotic illness, are far more likely to kill someone than someone with schizophrenia.  It’s revolting that the media reports these extremely rare incidences so ignorantly and sensationally.  These incidences, too, are usually caused by the person having a delusional belief that the other is going to hurt them so they are acting in perceived self defence.  And many high profile cases of people with schizophrenia committing violent acts have been documented as being caused by delusional beliefs like they must make a sacrifice to god, and similar.

So these people, no, they are not responsible for their acts because the act was for a) no gain b) no rational reason c) out of their control.  This doesn’t mean that I think everyone with schizophrenia who is violent is acting out of these reasons, but in the cases where it’s proven that they are then I don’t think they are responsible.

Another reason for my belief that mental illnesses are biologically based is that some respond to therapy for  biological disorders like epilepsy and that symptoms similar to those of mental illnesses occur in physical disorders like Multiple Sclerosis and traumatic brain injury.

And then there’s anecdotal evidence i.e my experiences: although I certainly had a traumatic upbringing, I am, for the most part, quite well adjusted emotionally.  It’s my mood that isn’t, and it has always felt physical to me.  I’ve been officially unwell for about eleven years, although I was always “odd”, and I have searched for causes and triggers but found few.  My moods don’t seem to be reactive.  But that’s just me.

Mental illness also runs in my family.

Both of my parents suffered from severe mental illness. My mum has mentalism unspecified.  I don’t talk about her very much, because I’m quite angry with her at the moment for her shenanigans, and I don’t want to misrepresent, or be hurtful, to her.  I love her, she’s my mother, but she’s really not a good mother at all, and I’m not sure I’d even say she was a good person.  She spent a lot of time in a mental hospital, she is violent (less so these days, but although my dad was the drunk, he wasn’t violent.  My mum hit her, and she also beat the shit out of us), she is a compulsive liar, she’s cruel, especially to animals (she put down all of my pets, for absolutely no reason other than not liking them, with no regard for how it might make me feel, or how the poor, completely innocent animal would feel which I hate her for.  She “accidentally” put our cat in the washing machine, where it died a horrible death.  I think she’s actually physically killed some of my pets and lied about taking them to the vets), she’s suffered from episodes of depression, psychosis and mania, in which she’s blown all her money,  she doesn’t “feel” emotions like love or anything properly, and a lot of other things.  Rob hates her.  She is probably has manic depression (I don’t want her to because I don’t want to be anything like her), but there is definitely something else up, there, and I’ve often wondered if she is a sociopath.  She tried to kill herself a lot and dotted her suicide notes around the house.  She’s not as bad now. Her mother suffered from mental illness, too.

My dad suffered from severe depression and alcoholism, and he tried to kill himself a lot too before his drinking did it for him. His parents were alcoholics, too.  All of my siblings have suffered from depression at one point or another.  I’m the only one with manic depression, though.

(God, Seaneen, growing up with that, no wonder you have a mental illness!  Isn’t it obvious that they fuck you up, your mum and dad?   Who wouldn’t go mad? Well, yeah, to a degree.  But even though we looked after our parents rather than vice versa, the biggest things that my upbringing and life in Belfast have given me is a lot of perspective, and a close relationship with my brilliant siblings).

I don’t believe, however, that just because one has a diagnosis of a mental illness that they need medical treatment.  I probably should, if I believe that they’re biologically based.  But I think it’s a sliding scale, like anything else, and that not everyone is affected to the same extent.  Some people can get by without, some people don’t want to take medication because they like how they are, some people don’t want to take medication because they don’t trust it, and some people respond better to therapeutic treatments.

I also don’t believe, and this is something that some have misunderstood, that because you’re diagnosed with mental illness, that’s you, for life.  Maybe so in your medical records but although I’m critical of the use of the word “label”, if people choose to see it that way, then they’re free to discard that at will.  And some people do recover from the symptoms that are the basis of that diagnosis and some people are undoubtedly misdiagnosed.  Diagnosis can change, too.  Bipolar disorder II can become I when someone has a manic episode, bipolar disorder can be schizoaffective disorder, which is relatively unknown, so not diagnosed so often, and depression can be diagnosed as bipolar disorder when antidepressants boot someone into mania.

I don’t think the diagnosis of mental illness should be taken lightly, so I don’t believe that one psychiatrist should have the last word.  I think a person should be given the right to question that diagnosis and see another psychiatrist or doctor of their choice.   If the diagnosis is given again, maybe it’s right but if not, scratch it from the records.  Likewise if someone has recovered and not displayed any symptoms that interfere with their ability to live for a long time, then the records should be amended so one is not just “manic depressive” forever, but “recovered/in remission from manic depression”.   I know too well that a diagnosis of mental illness can hamper your professional and personal life.  (For example, until I am officially very very stable, I can’t study nursing, which is my chosen profession second to be being a writer for a living, and I almost certainly won’t able to adopt, which is sad because I am wary of having my own children due to post natal psychosis.  I also got the sack from a temp job after they found my blog.  The worst thing was that they made up a lie about it).

I do think, personally, that it’s an illness and one I will have to carefully manage for the rest of my life.  Although a psychiatric model says such and such, I don’t think people have to put any faith in it if they don’t want to.  I do, because psychiatric help is helping me.  Yep, some medications have utterly fucked me up and it has been hit and miss but I do have a notoriously tricky type of manic depression to treat, and although I’m still ill, I am for the most part, a lot saner than I was, because I was desperately ill for a long time, and I didn’t know that I was.

I did question my diagnosis (which is bipolar I disorder, rapid cycling, with psychotic features) and I also asked for many second opinions.  I wasn’t beaten into submission, it was just rediagnosed many times, and I guess I knew anyway.

Of course then there’s the problem of the symptoms of mental illness also not being scientifically measurable but that’s another story.  In short, with me, I accept the diagnosis and treatment of my own problems as a mental illness because it messes up my ability to live a normal life, and affects my very basic functioning.

That’s also why I’m not against psychiatric medications, though this is a minefield.  I think it has to be weighed up; risk versus benefits like any treatment for any illness.  They can have great risks.  SSRI sexual dysfunction is devastating.  I think people need absolutely to have it painstakingly made clear what the risks are and nothing should be withheld from them.  It is heavy stuff.

Some people will respond disastrously to medication, some people will hate the side effects so much that it’s not worth it and for some people, it will help them to live a life they’re happier with, and if that’s the case, then let them take medication. I think it’s always worth trying medical treatment. Lithium has been proven effective in treating bipolar disorder, and antipsychotics are effective in treating psychosis.  Whether those symptoms should be treated, ie are they sociological rather than biological? matters little to me if the individual wishes to pursue the treatment because the symptoms were impacting on their ability to live and to be happy, two things that everyone should have the right to.

I get extremely pissed off by the survivor movement and the anti-psychiatry movement discounting the desires of the individual and referring to all people in the psychiatric system as “victims”.  It’s incredibly insulting and infantalising.  Unless there’s coercion, and there often isn’t, then it is entirely up to the individual to take medication and if they personally find that it helps them live a happier life then that’s their prerogative and they are not victims.

The survivor and antipsychiatry movement promotes the idea that “mental illness” is indeed an “inverted comma”.  They can think that if they like, but it’s up to the individual to decide if that’s what they think.  They’re not weak.  Not victims.  The mind is not collective, and it’s irresponsible to portray people as victims as a whole.  I have been signed up to loads of mailing lists against my will and I find it upsetting to be referred to in such a way when I put a lot of effort and thought into getting well. Taking medication or believing, saying and whatever that you have a mental illness is not dooming yourself nor buying into the lie.

There’s also Mad Pride and the culture of madness.  I’ve talked about that before, but just because I believe in the “illness” part doesn’t mean that I think that the experiences, perceptions and so on aren’t and cannot be incredibly valuable and wonderful.  We all know that a lot of the greatest art was born out of madness.  Hence why I don’t think people should be automatically treated for it, it’s up to them.  Nor that it couldn’t or shouldn’t be part of your identity. It’s part of mine, even though I am someone who would rather not have been born with manic depression.  It does, though, as you know, personally irritate the hell out of me when people see bipolar disorder as some sort of artistic, middle class syndrome, when, in my working class, no education, on benefits because I’m too ill to work, not getting anything “artistic” done because I’m either too depressed or too hyper to focus, often incapacitating and managing, because I really, really try, to write blog posts so that I’ve completed something, and then spend the rest of the day just trying to calm down enough to leave the house and feed myself, and my speech, my ability to think straight, paranoia and memory, is quite badly affected by it.  I spend most of my time alone, or with Rob, because certain symptoms I still really struggle with are socially embarrassing or weird to people who don’t know me.  And I nearly get run over everyday.

The assertion that those who pursue psychiatric and therapeutic treatment for mental illness are “not taking responsibility for themselves” and following the “big pharma” also bothers me deeply.  I think that acknowledging that one might have a problem, if it’s gotten to the point where it’s messing your life up, and actively doing something about it (and if that something is psychiatric treatment, that’s their choice, just because it’s not yours doesn’t make it wrong), is an incredibly responsible and admirable thing to do.  In my case, my illness was destroying my life and the lives of those around me; taking the bull by the horns by accepting my diagnosis, pursuing treatment and turning the glare inside so that I can understand myself and manage my illness, write this blog almost every day as a connection to myself, quitting drinking and so on, has been exhausting but I think it’s a responsible thing that I’m doing. The introspection and self examination needed to withstand treatment requires strength.  I work with my CPN (and the two CPNs I’ve had since I’ve moved to this borough have helped me in so many ways, not least by making sure that I have enough money to live on, and somewhere to live) and my psychiatrist, and I physically, mentally and emotionally could no longer cope with trying to deal with my illness on my own by the time I was hospitalised.    It was nine long years, from when I was very young, in which I had no help.  I was going to die without help.  I need that help and it doesn’t make me weak.  I find it offensive that it’s implied that me and the many other people in a similar position to me are victims.

In my case, antipsychotics (and will likely be taking other medications again, for now, I am only on one as an antidepressant wrecked me to the point of a suicide attempt and has kicked off rapid cycling again, and I’m out of mood stabilisers- see, medication isn’t perfect and I don’t think it is), which I do take, have very much helped my recurring paranoia and psychosis that fucked my life and my memory up and have also helped curbed mania.  I did gain a lot of weight (all of it which I’ve lost now, and a stone extra) and they’ve also affected my memory, but I decided that was worth it to be free of psychosis, which I largely have been now for some months (with a blip in August, during which time I had stopped taking my medication).

What I don’t support is involuntary treatment except in the case where the person might kill themselves and are not thinking rationally, or when the person is in danger of harming someone else.  Aside from this, I think every person should have the right to stick two fingers up and go their own way.  But I do think that anyone withdrawing from psychiatric medication should do it under supervision.

I think that medicating children is involuntary, therefore I’m completely opposed to it.  I also don’t think psychiatric diagnosis should be given to anyone under maybe the age of sixteen because, let’s face it, children and young adolescents are going through the wringer and they’ll be all over the place anyway.  I think diagnosis should only be given in the most “this could be nothing else” situations.  And yes, I do apply this to myself, who was diagnosed mood disordered at sixteen.  Of course had I had proper treatment early it might have saved me a lot of destruction and I was pretty severely ill at that age, but I am quite glad that I wasn’t until my twenties because it left no doubt in my mind that I wasn’t well as a teenager, rather than just, well, a teenager.

I also think that diagnosis of mental illness is a big deal.  Although I don’t consider it a label, personally, it does have social implications due to the widespread ignorance and discrimination of the world at large, and that can be incredibly hard to deal with.  I think physical causes should be investigated fully first (in my case, an EEG for epilepsy some years ago) before mental illness is considered, and I think that mental illness should not be freely or dismissively diagnosed.

The DSM-V is approaching, and although the DSM-IV is flawed to hell,  I agree with Furious Seasons that there’s likely to be a “softening” of the bipolar disorder diagnosis.  Although I agree with recent changes to the diagnostic model (of bipolar as a spectrum disorder), I think people should be very careful about diagnosing it.

Likewise, I am worried about the increasing medicalisation of human emotion, and the widening of definitions, which is what a lot of anti-psychiatry people go on about.  I agree to an extent that this happens and this is why I think mental illness should only be diagnosed with symptoms severely impede someone’s ability to function, or their ability to perceive reality in a way that doesn’t jeopardise their safety.  I think antidepressants are over prescribed, which is why they’re limited in effect, and are a sticking plaster in many cases.  I support therapeutic treatment for reactive depression, with medication for severe cases.  Some people are depressed because they should be, and they need counselling and practical help.

Nowadays there are many lifestyle articles with quizzes like, “Do you worry too much?” trying to diagnose anxiety disorders and such.  Worry is not an anxiety disorder, anger is not a disorder, sadness is not a disorder, nor is happiness.  Words like “manic” have slipped into colloquialisms and are now meaningless.  The word psychotic is consistently misused as a description of psychopathy.  If anything’s really excessive and buggers up your life, then maybe there’s a problem that needs investigating, but emotions are not disorders, they’re emotions.  Life is unstable, moods naturally fluctuate, people get stressed and people lose their temper.  People are wonderfully idiosyncratic and strange and it’s just human nature.  Everyone will have had a few symptoms of mental illness at some point in their life (who hasn’t been depressed?).  The widening of definitions should be resisted.

And I also hope very much that no-one involved in the DSM-V has any vested interest; i.e links or support from the pharmaceutical industry which undoubtedly has a lot to gain from the diagnosis of mental illness.  Psychiatry as a profession is already viewed with suspicion.

Anyway, those are my views on some of the burning (like cystitis…and we’re back to pissing) issues.  What are yours?